{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T03:54:10Z","timestamp":1793764450756,"version":"4.6.1"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2020,3,5]],"date-time":"2020-03-05T00:00:00Z","timestamp":1583366400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5T32AI100851-02"],"award-info":[{"award-number":["5T32AI100851-02"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>We recently mitigated a clonal outbreak of hospital-acquired Mycobacterium abscessus complex (MABC), which included a large cluster of adult patients who developed invasive infection after exposure to heater-cooler units during cardiac surgery. Recent studies have detailed Mycobacterium chimaera infections acquired during cardiac surgery; however, little is known about the epidemiology and clinical courses of cardiac surgery patients with invasive MABC infection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively collected clinical data on all patients who underwent cardiac surgery at our hospital and subsequently had positive cultures for MABC from 2013 through 2016. Patients with ventricular assist devices or heart transplants were excluded. We analyzed patient characteristics, antimicrobial therapy, surgical interventions, and clinical outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Ten cardiac surgery patients developed invasive, extrapulmonary infection from M. abscessus subspecies abscessus in an outbreak setting. Median time from presumed inoculation in the operating room to first positive culture was 53 days (interquartile range [IQR], 38\u2013139 days). Disseminated infection was common, and the most frequent culture-positive sites were mediastinum (n\u2005=\u20057) and blood (n\u2005=\u20057). Patients received a median of 24 weeks (IQR, 5\u201333 weeks) of combination antimicrobial therapy that included multiple intravenous agents. Six patients required antibiotic changes due to adverse events attributed to amikacin, linezolid, or tigecycline. Eight patients underwent surgical management, and 6 patients required multiple sternal debridements. Eight patients died within 2 years of diagnosis, including 4 deaths directly attributable to MABC infection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Despite aggressive medical and surgical management, invasive MABC infection after cardiac surgery caused substantial morbidity and mortality. New treatment strategies are needed, and compliance with infection prevention guidelines remains critical.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa215","type":"journal-article","created":{"date-parts":[[2020,2,28]],"date-time":"2020-02-28T20:19:19Z","timestamp":1582921159000},"page":"1232-1240","source":"Crossref","is-referenced-by-count":25,"title":["Invasive <i>Mycobacterium abscessus<\/i> Complex Infection After Cardiac Surgery: Epidemiology, Management, and Clinical Outcomes"],"prefix":"10.1093","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0914-0291","authenticated-orcid":false,"given":"Arthur W","family":"Baker","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA"},{"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen K","family":"Maziarz","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah S","family":"Lewis","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA"},{"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason E","family":"Stout","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deverick J","family":"Anderson","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA"},{"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter K","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob N","family":"Schroder","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mani A","family":"Daneshmand","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina, USA"},{"name":"Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara D","family":"Alexander","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA"},{"name":"Duke University Clinical Microbiology Laboratory, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Richard J","family":"Wallace","sequence":"additional","affiliation":[{"name":"Mycobacteria\/Nocardia Research Laboratory, Department of Microbiology, University of Texas Health Science Center, Tyler, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J","family":"Sexton","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA"},{"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron R","family":"Wolfe","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,3,5]]},"reference":[{"key":"2021040811224114900_CIT0001","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1093\/cid\/ciw122","article-title":"Healthcare outbreaks associated with a water reservoir and infection prevention strategies","volume":"62","author":"Kanamori","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2021040811224114900_CIT0002","first-page":"912","article-title":"Modern healthcare versus nontuberculous mycobacteria: who will have the upper hand?","volume":"64","author":"Crist","year":"2017","journal-title":"Clin Infect 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